Background

A well-known problematic sequela of chest wall resections is development of scoliosis. Despite the seriousness and frequency of scoliosis following chest well resection, the etiology and biomechanical information needed to understand this progression aren't well-known.

Methods

Range of motion of six specimen (C7–L2) was captured using a custom-built six degrees-of-freedom machine in each of three physiological rotation axes. Left posterior ribs were sequentially resected 7cm from the rib head, starting at the 5^th rib and continuing until the 10^th rib. Injured specimen were instrumented with unilateral anterior rod fixation and then with additional unilateral posterior fixation, each starting at T4 and then extended distally as ribs were resected. Relative motion between the constructs' proximal and distal ends was measured in all three axes for the intact, injured, unilateral anterior, and unilateral anterior with unilateral posterior constructs.

Findings

Raw motion of the injured specimen increased in a stepwise manner as ribs were resected. Averaged across all injury sizes, the unilateral anterior construct significantly reduced motion by 47.0±13.4% in lateral bending (P=.001). The combined anterior-posterior construct significantly reduced motion by 57.6±15.9% in flexion/extension (P<.001), 70.3±12.2% in lateral bending (P<.001), and 51.1±14.5% in axial rotation (P<.001). Combined anterior-posterior fixation was significantly more stable than anterior-only fixation in flexion/extension (P=.002).

Interpretation

Regardless of injury size, posterior rib resection did not create significant immediate instability of the thoracic spine. Concurrent spinal stabilization was shown to maintain thoracic spine stability. Combined anterior-posterior fixation proved to be significantly more rigid than an anterior-only construct.

中文翻译：

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不同尺寸胸壁切除术后潜在预防性脊柱侧凸治疗的生物力学研究

背景

胸壁切除术的一个众所周知的有问题的后遗症是脊柱侧弯的发展。尽管胸腔切除术后脊柱侧弯的严重性和频率很高，但了解这种进展所需的病因和生物力学信息并不为人所知。

方法

使用定制的六自由度机器在三个生理旋转轴中的每一个上捕获六个样本 (C7-L2) 的运动范围。左后肋依次切除7厘米从肋头，开始于5^个肋和持续直到10^个肋。受伤的标本采用单侧前杆固定，然后进行额外的单侧后固定，每个从 T4 开始，然后在肋骨切除时向远端延伸。对于完整的、受伤的、单侧前部和单侧前部与单侧后部构造，在所有三个轴上测量构造的近端和远端之间的相对运动。

发现

随着肋骨被切除，受伤标本的原始运动以逐步的方式增加。平均所有损伤大小，单侧前构造显着减少了 47.0±13.4% 的侧弯运动 ( P =.001)。前后组合结构显着减少了 57.6±15.9% 的屈曲/伸展运动 ( P <.001)、70.3±12.2% 的侧弯 ( P <.001) 和 51.1±14.5% 的轴向旋转 ( P < .001) .001）。在屈曲/伸展时，前后联合固定明显比仅前路固定更稳定（P = .002）。

解释

无论损伤大小，后肋骨切除术都不会造成胸椎立即出现明显的不稳定。同时脊柱稳定被证明可以保持胸椎的稳定性。联合前后固定被证明比仅前路结构更坚固。